The fairness debate will put health back on the front pages

An unlikely combination of Rupert Murdoch, Cornish pasties, duff advice on fuel storage, double dip recessions and queues at airport immigration desks has conspired to push health further down the news bulletins over the past month.

This week, HSJ reports signs that the sector’s lower profile will be predictably short lived.

For the last year, health secretary Andrew Lansley has been in the media spotlight as he painfully forced the Health Bill through Parliament. This high profile means that whatever the long term success of clinical commissioning groups and the NHS Commissioning Board, the Conservatives’ neutralisation of health – Labour’s trump card before David Cameron became the Tory leader – as a political issue at the 2010 general election seems a distant memory from a bygone political era.

The government has changed so many things that come the next election either its health achievements will be seen as electoral assets or it will lose the argument to those who can weave a health narrative combining discord about reform, spending restraint and performance of services.

But questions of fairness will also emerge – questions the government currently faces on many fronts. A Budget perceived by many as being ignorant of the pressures faced by those fabled “hard-working families” has given rise to accusations that we are led by “arrogant posh boys who don’t know the price of milk”.

Both Mr Lansley and the NHS now face the risk that controversial policies that would have been implemented without the act – from the £20bn savings programme to the franchising of hospitals to private operators – will become linked to the reforms in the minds of the public.

Profits are private providers’ requirement to enter into the NHS to diversify service provision and Circle faces a battle to turn around the fortunes of Hinchingbrooke. But in the current climate it is not difficult to imagine private providers’ fees being seen as an example of a society in which the perceived fatcats get the cream. That the franchising of Hinchingbrooke was first contemplated under a Labour government will not necessarily be remembered by the electorate.

It is overly simplistic to suggest that this principle would result in cash being transferred from poorer Labour-voting areas to richer Conservative-voting retirement resorts.

However, the issue, like NHS competition and so many of the problems with which the government is grappling, is linked to wider questions about the fairness of society in tough times. It is this debate that will determine the political mood over the next year and, potentially, the fate of this government.

Readers' comments
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I wonder how many colleagues are aware of the OFT market studies into the viability of private primary health care?

This is a significant departure from the OFT's previous position (spelt out in policy paper OFT 443); the terms of the definition of what is and isn't a relevant market, and what is meant by a general interest and how this is different from an economic interest are now showing up.

I also wonder whether or not the Social Values Bill will mitigate against competitive process for GP or nurse led social enterprise. Competition law like the Enterprise Act 2002, makes it pretty clear what is and isn't concerted practice, just how the Commissioning Board will make sense of 2,3 and 4 provider clinical supply chains is anyone's guess.

Confused? We sure will be. especially if exemptions from competive process are sought by local authorities, (we must remember that services by one public authority are tyed to that of the others) under their s2 LGA 2000 wellbeing powers.

Third party provision of health and social care is not new, our collective understanding of how the market and competitive process will impact is.

Congratulations to HSJ for uncovering the Hinchingbrooke deal and questions arise about why now and not when the contract was let. It will not complete the ten years but will make money for a few.On the wider issue you are right to refer to the Laurel and Hardy government (by implication & younger readers Google L&H). In terms of NHS privatisation I can think of another vulnerable duo - Hansel and Gretel who spy a house of goodies in a dark wood but this time no happy ending.

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